Worcester County Local Health Improvement Process

Public Health Assessment and Wellness

Boston Lead Paint Initiative

State: MA
Type: Promising Practice
Year: 2016

ABSTRACT:

The Boston Public Health Commission (BPHC), the country’s oldest health department, is is an independent public agency providing a wide range of health services and programs. Our mission is to protect, promote and preserve the health of all Boston residents, particularly those who are most vulnerable. Since 1971 the BPHC Childhood Lead Poisoning Prevention Program has been actively engaged in elimination of childhood lead poisoning in the City of Boston for families with children under six years of age. Today, the incidence rate for lead poisoning in Boston is 0.4%. Together, with the Office of Fair Housing and Equity, the Inspectional Services Department, and the Department of Neighborhood Development and Suffolk University Law School, the programs form the Boston Lead Paint Initiative, a collaborative effort to create a lead-safe Boston.

ORGANIZATION:

Boston Public Health Commission

TITLE:

Boston Lead Paint Initiative

The BPHC serves the City of Boston. With a population of 617,594, Boston is the largest city in New England.1 In 2010, the city’s major racial and ethnic groups were White non-Latino (47%), Black, non-Latino (22.4%), Latinos (17.5%) and Asian, non-Latino (8.9%). About a quarter of city residents were born outside the U.S., and 35% reported speaking a language other than English at home. Boston has a large low-income population: 23% of residents lived below the poverty level in 2010, about 1.5 times the U.S. rate.
Boston has the 3rd oldest housing stock in the country – almost 90% was built before 1978, meaning many homes contain toxic lead paint. Lead is a neurotoxic substance. Even a small amount can harm a child’s health and research has shown the change in a blood lead level from 0 to 1 is more harmful than the change from 4 to 5 or 8 to 9, for example. State law requires that property owners remove or cover lead paint hazards from a residence where a child under 6 lives, at the expense of the owner. The law was intended to promote lead-safe homes, but in practice, property owners have an incentive to deny renting to families. Since families are a protected class under the Fair Housing Act, this practice, though widespread, is illegal.
Today, the incidence rate for lead poisoning in Boston is 0.4%. Together, with the Office of Fair Housing and Equity, the Inspectional Services Department, and the Department of Neighborhood Development, and Suffolk University Law School, the programs form the Boston Lead Paint Initiative, a collaborative effort to create a lead-safe Boston.
Since 1971, the BPHC’s Childhood Lead Poisoning Prevention Program has been actively engaged in elimination of childhood lead poisoning in Boston for families with children under six years of age. In an effort to create healthier homes for the children and families of Boston, Mayor Martin J. Walsh launched the Boston Lead Paint Initiative in October of 2014 with two main goals:
(1) Reduce the number of children exposed to lead paint and the number of families victimized by housing discrimination related to lead paint, and
(2) Increase the number of lead safe units and lead safe renovations on older homes and public education on the problem and available resources
The initiative established a Lead Paint Work Group, comprised of public health officials, lead experts and healthy home advocates. The group meets every other month to discuss lead-related efforts and, at the start of 2016, will develop recommendations to address housing discrimination against Boston families and non-compliance with the Massachusetts lead law.
Each department has established the following measurable goals over the next five (5) years:
-Department of Neighborhood Development (DND) Lead Safe Boston will "de-lead" 400 housing units (80/year).-Fair Housing and Equity and BPHC will educate 2,500 at risk residents on fair housing and lead awareness (500/year).-Inspectional Services will conduct 325 lead determinations in high risk units (65/year).-BPHC will train and license 500 contractors in lead safe renovation (100/year).-BPHC will train 250 homeowners in do-it-yourself moderate risk deleading (50/year).
Department goals were intended to be met over a 5-year period. Below are the actual 10-month outcomes relative to the yearly measurable goal:-DND Lead Safe Boston: 43 deleaded this year (annual goal of 80)-Fair Housing and Equity and BPHC: 4469 households educated this year (goal of 2,500)-ISD will conduct: 47 lead inspections this year (annual goal of 65)-BPHC: 22 contractors trained and licensed this year (annual goal of 100)-BPHC: 96 homeowners trained this year (annual goal of 50)
At the 10-month point for the year, we have met or exceeded some objectives, though not all. The pace of activities has been increasing throughout the year. The city’s Office of Fair Housing and Equity is writing a report to HUD based on the recommendation of the Lead Paint Work Group.
Several factors contribute to the success of this practice:
-Local Families who experienced housing discrimination and have children with elevated blood levels completed interviews in the Boston Globe about their experiences. -DND received increased deleading funding from HUD.-Boston Mayor, Martin J. Walsh has recognized the multi city department collaboration as an internal best practice. -The Boston Lead Paint Initiative submits quarterly reports to the Mayor on it’s progress.
Establishment of the practice has led to the development of educational materials providing information on lead and lead-related resources offered by the city. This allows Boston residents to access all necessary information in one location. A large number of Boston residents have also been educated and/or trained in lead-safe practices. As a result, children and families are better protected against lead poisoning and housing discrimination.
http://www.bphc.org

Boston has the 3rd oldest housing stock in the country – almost 90% was built before 1978, meaning many homes contain toxic lead paint. Lead is a neurotoxic substance that has been shown to impact a child’s IQ, behavior, learning abilities, developmental progress, and nervous system. In 2014, 4,969 children between 9-47 months tested at or above a blood lead level of 5 µg/dL.
The Massachusetts Lead Law requires that property owners remove or cover lead paint hazards from a residence where a child under 6 is living. The property owner must bear the cost of the renovation. The law was intended to promote lead-safe homes, but in practice, the law has given property owners an incentive to deny renting to families. Since families are a protected class under the Fair Housing Act, this practice, though widespread, is illegal.
Approximately one quarter of the housing discrimination cases the Boston Office of Fair Housing sees are related to family status and lead paint in the home. Families can be denied housing outright, or steered to live in certain lead-safe units that may be less than ideal for the renter. Renters who use a Section 8 voucher also experience housing discrimination because landlords who rent to those individuals must have their housing units inspected for hazards such as lead paint. If a landlord knows he/she has lead paint in their unit, but does not want to make the home lead-safe, they will refuse to rent to families with Section 8 vouchers. Roughly 20% of the housing discrimination cases the Office of Fair Housing and Equity sees are related to Section 8 voucher use by renters who may also have small children.
While nearly all homes in Boston contain lead paint, and all families can experience housing discrimination, 5 census tracts in Boston have been identified as high risk. Dorchester tracts 920, 924and 1005; Hyde Park tract 1404; and East Boston tract 502. The defining characteristic of the high risk tract is one with more than 50 children with blood lead levels at or above 5 µg/dL. Other characteristics of these tracts include low-income individuals, majority individuals of color, and majority immigrant populations. Therefore, lead hazards not only impact health and encourage discrimination, but they also contribute to the health disparities faced by communities already at risk of other adverse health outcomes.
The 2010 census reported that roughly 34,000 children under age 5 live in Boston. The main goal of the Boston Lead Paint Initiative is to educate and protect the families of these children. While all Boston children who spend time in a pre-1978 building are at risk, 5 high-risk census tracts have been identified: Dorchester tracts 920, 924, 1005; Hyde Park tract 1404; and East Boston tract 502. These tracts have over 50 children who tested at or above 5 µg/dL, the CDC recommended reference value for medical intervention and environmental investigations. Other characteristics of these tracts include low-income individuals of color, and immigrant populations.
The Office of Fair Housing and Equity and BPHC reached 4,469 persons in the Boston-area through targeted outreach and tabling events in neighborhoods in which high risk census tracts have been identified, education seminars in various parts of Boston, and literature drops in high risk communities. This is approximately 13% of the target population in less than one year.
Boston departments had largely worked separately to address the issue. They attempted to bridge this gap with a Boston 2010 Collaborative an initiative similar to the Boston Lead Paint Initiative, but it was gradually disbanded after it met it goals and funding ran out. The current Initiative has the support of Mayor Walsh, the Office of Fair Housing and Equity. BPHC coordinates these efforts.
The current practice is better because it represents an inter-agency effort to create a lead-safe Boston and address a previous non-targeted effort of housing discrimination and lead paint. Data and resources sharing are coordinated across city of Boston departments as part of this initiative and GIS themed maps are created to better illustrate health outcomes in targeted high risk neighborhoods. There are 5-year measurable benchmarks and objectives for success, including establishing a Lead Paint Work Group tasked with providing recommendations to the Department of Housing and Urban Development for reducing housing discrimination due to the presence of lead paint. This effort also has accountability to the Mayor through quarterly Boston Lead Paint Initiative reports and quarterly reports including lead paint initiative progress as part of the Mayor’s Healthy Homes reporting.
The current practice is innovative because it represents a newer, more effective way to measure the effects of housing discrimination by property owners against parents with young children due to the lead paint status of their dwelling and demonstrate accountability through the Lead Paint Initiative.

Since 1971, the BPHC’s Childhood Lead Poisoning Prevention Program has been actively engaged in elimination of childhood lead poisoning in Boston for families with children under six years of age. In an effort to create healthier homes for the children and families of Boston, Mayor Martin J. Walsh launched the Boston Lead Paint Initiative in October of 2014 with two main goals:
(1) Reduce the number of children exposed to lead paint and the number of families victimized by housing discrimination related to lead paint, and
(2) Increase the number of lead safe units and lead safe renovations on older homes and public education on the problem and available resources
The initiative established a Lead Paint Work Group, comprised of public health officials, lead experts and healthy home advocates. The group meets every other month to discuss lead-related efforts and, at the start of 2016, will develop recommendations to address housing discrimination against Boston families and non-compliance with the Massachusetts lead law.
Steps taken to implement the program:
Created Lead Paint Work Group to develop recommendations for HUD to address housing discrimination due to the presence of lead paint
Created interagency goals to hold each City of Boston initiative partner accountable
Signed a memorandum of agreement to align these goals with future funding requests and ensure each agency shared data towards goal.
As discussed, the focus is on children I 5 high-risk census tracts.
The city agencies began meeting in summer of 2014 to plan the BLPI and Lead Paint work group. Data collection began January 2014 and the initiative 5 year goals are through January 2019.
- Long-term goal is to create a lead-safe Boston- Inter-city goals are 5-years
The Lead work group involves 18 agencies representing academic, medical, occupational, consumer advocacy, and state and local governmental sectors.
A Lead Paint Summit was held in October 2014 for Community Stakeholders in Boston.
Major stakeholders include the city involved with the Boston Lead Paint Initiative (Inspectional Services Department, Office of Fair Housing, and Department of Neighborhood Development). The Lead Paint Work Group represents more than a dozen lead-related stakeholders, such as community members, and lead remediation services.
The Lead Paint Initiative received a $10,000 grant from HUD for costs associated with the Lead Paint Work Group. The funds were used for the following:
- In-kind Staff Costs: One public health intern in the role of Project Coordinator (Unpaid Projected Cost May 2014-December 18 2015 (34 weeks at $14/hour or $6,664).- Other Lead Paint Initiative staff time since January 2014 to present 10% of FHE ED and DD time $18,9005% of the Outreach Staff time $5,500.- All printing and design of Lead Brochures in English, Spanish, Chinese, Cape Verde Creole, and Haitian Creole $5,000.- 10% of Outreach Staff time from the Boston Public Health Commission, the Department of Neighborhood Development staff, and Inspectional Services Department at $ 12,000.- BPHC Intern to continue Project Coordination in 2016 $10,000.

What did you find out? To what extent were your objectives achieved? Please re-state your objectives from the methodology section.
Since 1971, the BPHC’s Childhood Lead Poisoning Prevention Program has been actively engaged in elimination of childhood lead poisoning in Boston for families with children under six years of age. In an effort to create healthier homes for the children and families of Boston, Mayor Martin J. Walsh launched the Boston Lead Paint Initiative in October of 2014 with two main goals:
(1) Reduce the number of children exposed to lead paint and the number of families victimized by housing discrimination related to lead paint, and
(2) Increase the number of lead safe units and lead safe renovations on older homes and public education on the problem and available resources.
Practice has been evaluated each month through data collection by individual offices.
Primary data sources were the Department of Neighborhood Development, the Office of Fair Housing & Equity, the Boston Public Health Commission, and the Inspectional Services Department.
Data collected was specific to the goals set by each department.
DND Lead Safe Boston: 43 deleaded this year (annual goal of 80)
Fair Housing and Equity and BPHC: 4469 households educated this year (goal of 2,500)
ISD will conduct 47 lead inspections this year (annual goal of 65)
BPHC: 22 contractors trained and licensed this year (annual goal of 100)
BPHC: 96 homeowners trained this year (annual goal of 50)
Results were analyzed based on the yearly goals created and the exact population reached. For example, one goal was to educate 500 households per year, so data collection only included numbers in settings/events where target households would be located.
The Office of Fair Housing modified education and outreach methods due to low turnout at community presentations focused on lead paint as a public health and fair housing issue. FHE also received feedback via informational interviews that the constituents who come out to attend this specific topic are constituents either already affected by the issue and or are advocates currently working on the issue of lead paint health effects and or related housing discrimination. As a result, we have changed the outreach strategy to attend existing outreach events that reached a larger and broader audience. This method has made outreach and education on Boston resources much more successful.
Since there is no “one stop shop,” for all lead paint resources in the City, the initiative partners developed simple educational materials that detail city resources available to constituents for Lead paint training, de-leading, education, and housing discrimination.

While lead paint remains an obstacle in children’s environmental health and fair housing, it is not a topic that garners a lot of interest on its own due to the longevity of its targeted efforts in Boston neighborhoods. Our partnership discovered this early on. As a result we learned not to communicate lead paint as a stand alone hazard, but as it relates to public health and fair housing. Allowing our audience to view lead in a broader sense has improved outreach and public reception.
Managing an initiative across City departments that are not in the same cabinet or building requires commitment from the leadership of each cabinet and department head. The Mayor’s strong support for this collaboration across departments has lead to more data sharing, and has also helped to ensure press and media coverage highlighting lead paint as an issue that is still important to Boston children and families. Quarterly reports to the Mayor’s office has led to greater accountability between partners and has elevated the visibility of the initiative within the City. It is also best to have at least one departmental role for an individual who is solely responsible for collecting data and maintaining open communication between departments. The efforts prior to this Initiative did not designate a person for these activities which, along with other factors, may have contributed to its gradual disbanding.
This partnership has also brought to the light the need for data on perceptions of lead paint as a health hazard and the experience of housing discrimination by families who rent in Boston. The Office of Fair Housing is currently contracting with a vendor to conduct a survey as a method to collect this data.
There is sufficient stakeholder commitment in the City of Boston at the state, local and community level to sustain the Lead Paint Initiative over the next five years. The Lead Paint Working Group will meet monthly to review progress on the five year goals set at the Lead Paint Summit. Both long term and short term goals and outcomes will be evaluated and changes made to our strategic plans so that policy can be set citywide. Lead Paint Summits will be held annually to report on the success of the Lead Paint Initiative to the larger stakeholder community. This strategic plan has the support of the Mayor of the City of Boston.
The Office of Fair Housing and Equity will officially shift its role from leading this initiative in Spring of 2016 when the Boston Public Health Commission will take the lead in convening the Lead Paint Work Group and in leading the effort in reporting on the Boston Lead Paint Initiative.